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Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money.

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money. Check out Lynn’s previous Meaningful Use Monday posts.

Included in the Proposed Rule for Meaningful Use Stage 2 are several modifications to the requirements for Meaningful Use Stage 1—likely in response to a barrage of comments from providers.

The MU Stage 1 measure requiring a test of the ability to exchange clinical data would be removed effective 2013. Apparently, the concept of a test created a great deal of confusion. This change, however, should not be interpreted as reduced interest in interoperability. In fact, Stage 2 is all about the sharing of data. The measure would be replaced in Stage 2 by numerous other measures that require the sharing of clinical information—both between providers and with patients.

The “all 3 vital signs dilemma”, (described in a previous Meaningful Use Monday post), would be resolved by a change to the vital signs measure. Separating height and weight from blood pressure, the revised measure would allow a provider to meet the threshold for recording height and weight, while claiming an exclusion for blood pressure, (or vice-versa). This is good news for specialists like orthopaedists who may routinely document height and weight but who rarely document blood pressure unless it is relevant to a specific patient’s problem. This change would be available as an option in 2013, and formalized in 2014. (The vital signs measure would also increase the minimum age requiring blood pressure documentation from 2-year olds to 3-year olds.)

Many providers reported a problem in meeting the CPOE measure because of the way the calculation was defined—particularly those providers whose treatment does not frequently include prescribing medication. Now, providers would be able to define the denominator as the number of medications ordered, rather than the “number of unique patients with at least one medication in the patient’s medication list”, (since that list often includes medications downloaded from Surescripts and prescribed by other providers.) There is already a CMS FAQ (#10369) that allows providers to use this alternate definition even in 2012.

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money.

To follow up on The “All 3” Vital Signs Dilemma and the posted comments, I want to provide some clarification regarding the vital signs measure and correct some common misconceptions about the requirements:

Meaningful Use Core Measure: Record Vital SignsFor more than 50% of all unique patients age 2 and over seen by the EP, height, weight, and blood pressure are recorded as structured data.

The Exclusion: A physician who does not currently track height, weight, and blood pressure does not have to start taking vital signs solely for the purpose of meeting meaningful use. The point I made in last week’s post was that the exclusion may be difficult for some providers to take advantage of due to the “all 3” requirement—but it is available for those who attest that “all 3 vital signs have no relevance to their scope of practice.” A psychiatrist, for example, could likely attest to this exclusion; and the exclusion would satisfy the measure.

The physician (or staff) does not have to record the vital signs at each patient visit. It is up to the physician’s discretion how frequently—on a patient-by-patient basis—this clinical information should be updated.

In fact, the measure does not even require that the data be entered during the reporting period. It only requires that the vital signs be in the EHR charts (of 50%) of the patients who were seen during the reporting period. This means that the data could already be there from a past visit—even a visit that occurred prior to the reporting period.

The physician (or staff) does not have to be the source of the vital signs data. It can come from another provider or directly from the patient—electronically, on paper, entered through a portal, or in any other way.

Regarding last week’s comments….I wholeheartedly agree that meaningful use should not be the predominant reason for a provider to adopt an EHR. An EHR should be implemented based on of its ability to deliver benefits related to practice efficiency, physician productivity, and quality of care. With the right EHR, these benefits will far exceed the potential $44,000 incentives.

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money. Check out Lynn’s previous Meaningful Use Monday posts.

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money.

How does a physician meet this measure if only one or two, but not all three, of the vital signs are a routine part of their practice? This is an issue on which I have sought clarification since before my first Meaningful Use Monday post. The question has now been asked frequently enough to warrant a formal answer on the CMS FAQ site—and the answer is problematic.

Meaningful Use Core Measure: Record Vital SignsFor more than 50% of all unique patients age 2 and over seen by the EP, height, weight, and blood pressure are recorded as structured data.Exclusion: Any EP who either sees no patients 2 years or older or who believes that all 3 vital signs of height, weight, and blood pressure of their patients have no relevance to their scope of practice.

You’d think this measure would be pretty straightforward—and it is, for primary-care physicians (and some specialists), for whom taking vital signs is a given. Other specialists, such as dermatologists, ophthalmologists, and psychiatrists, will likely attest that (all 3) vital signs are not a routine part of their practice, and they will meet the measure by attesting to an exclusion.

But how will other specialists meet and report on this measure? Some orthopaedists, for example, routinely* record height and weight, but few take blood pressure, (recording it only when documented—typically by the patient’s primary-care physician—for surgical clearance). ENT specialists may routinely* take blood pressure, but don’t record height and weight.

According to FAQ Answer ID# 10593, “If an EP believes that one or two of these vital signs are relevant to their scope of practice, they must record all three in order to meet the measure.” Therefore, specialists like the above have two choices if they want to demonstrate meaningful use:

Attest that all 3 vital signs have no relevance to their practice, or

Add the missing function(s) to their practice’s workflow, despite the lack of relevance.

*Note: “Routine” is a key word here. I received an e-mail from a senior CMS staff member saying that “there is nothing in the regulation that specifies that claiming this exclusion precludes an EP from recording these vital signs on an occasional basis.” Therefore, the dilemma exists only for those physicians who routinely record one or two of the vital signs.

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money. Check out Lynn’s previous Meaningful Use Monday posts.

Free EMR Newsletter Want to receive the latest news on EMR, Meaningful Use,
ARRA and Healthcare IT sent straight to your email? Join thousands of healthcare pros who subscribe to EMR and HIPAA for FREE!

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